COVID-19’S IMPACT ON SELF REPORTED INSOMNIA FROM APRIL 2020-APRIL 2021

Abstract

Introduction: Reports indicate that insomnia symptoms increased globally during the COVID-19 pandemic, though regional patterns within the United States remain unclear. It was hypothesized that participants in the United States South would have greater insomnia severity (Insomnia Severity Index; ISI) and poorer sleep quality (Pittsburgh Sleep Quality Index; PSQI), than participants in other U.S. regions during the COVID-19 lockdown. Methods: U.S. adults were surveyed between April 2020 to October 2021 (n ~ 1000 per month; ages 18-92) to assess sleep quality and insomnia using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Responses from Alaska, Hawaii, and non-U.S. territories were excluded to focus on continental regional trends. Chi-square tests were used to compare lockdown frequency by region. Mixed-effects models, controlling for demographics and including random intercepts for state, were used to examine associations between region, lockdown status, and sleep outcomes. Right-skewed ISI scores were analyzed using a Tweedie generalized linear mixed-effects model. Results: Lockdown prevalence differed significantly across U.S. regions ( χ²(3, N = 13,149) = 386.68, p < .0001, Cramér’s V = .17), with the West exhibiting the highest frequency of lockdowns. Participants were found to have a higher PSQI score (b = 0.32, p < .001) and ISI score (~13% increase, b = 0.12, p < .001) during lockdowns, but these effects did not differ significantly by region. Females were also found to have greater insomnia symptoms than males (b = 0.15, p < .001). In separate models where physical exercise was evaluated as a potential predictor, this was not significantly associated with PSQI or ISI outcomes. Between-state variance was minimal in all models. Conclusion: Lockdown status was associated with poorer sleep quality and greater insomnia severity across the United States, regardless of region. Although regional differences in lockdown prevalence were observed, these did not translate into regional differences in PSQI or ISI outcomes. Female sex was linked to increased sleep disturbances, while physical exercise was not a significant predictor. These findings highlight the widespread impact of pandemic-related disruptions on sleep. Future research should investigate behavioral and environmental factors that may contribute to variations in insomnia severity in the U.S.